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Category 4: Exposure to environmental risks in the home

If patients lived in an environment that was unclean, then this increased the risk of a patient getting an infection. (Dowding 2020) (U)

Nurses reported patients living in apartments without running water, or a working sink. (Dowding 2020) (U)

The nursing care environment varied from impeccably clean and tidy –without visible dirt, dust or damaged interiors –to dilapidated and contaminated households. The latter were littered with putrid waste, sticky floors, damaged interiors and inadequate lighting and lacked fresh air or adequate space for movement. (Wendt 2022) (U)

In some cases, there was not enough of a free flat surface to create a clean workspace. (Wendt 2022) (U)

There may be evidence of hoarding or the absence of adequate indoor plumbing, which can further complicate healthcare provision in the home. (Pogorzelska-Maziarz 2020) (C)

Category 5: Exposure to frequent personal interactions and unsafe caregiving by family members

When patients lived with many family members in close proximity and their infection control practices were not thought to be of a high standard, this was also seen as a risk factor. (Dowding 2020) (U)

Besides the client and nurse, other people, […] could be present during the delivery of care, varying from none to many; for example, healthcare staff, relatives, acquaintances, children, domestic help. (Wendt 2022) (U)

Some staff described difficulties with ensuring patient, family, and caregiver compliance with treatments and IPC procedures because home health staff are not present in the home all of the time. (Pogorzelska-Maziarz 2020) (C)

Patients who had caregivers or family that were not following advice or being involved in care were seen to be at an increased risk of developing infection. (Dowding 2020) (U)

Noncompliance was viewed as a major challenge; many participants gave detailed accounts of the lengths they went to teach patients and their families and caregivers about wound care, environmental sanitization, and medication adherence. (Pogorzelska-Maziarz 2020) (C)

Finally, many participants cared for a patient alongside other workers who entered and left the home each day. This added to their fear of transmitting COVID-19 to their patients and to one another. (Sterling 2020) (U)

Category 6: Unsafe storage and disposal of material and equipment in the home

Materials, tools and equipment needed for home-based nursing care were stored in various ways, sorted in plastic or cardboard boxes with or without a closable lid or loose in plastic or paper bags. These boxes or bags were kept on tables, chairs, the floor or under a bed. In some cases, a cupboard, dresser or desk was used to store materials using different drawers for different materials. In a few cases, there was no obvious place to store materials. (Wendt 2022) (U)

In some cases, sharps containers were full or filled above the ‘do not exceed’ line or handled inappropriately. (Wendt 2022) (U)

Some used materials and waste were also found scattered across various surfaces for the client or someone else to throw away. Additionally, food waste was observed in a few instances. On occasion, contaminated waste from a nursing procedure came into contact with other persons such as toddlers and spouses. (Wendt 2022) (U)

Category 7: Contact with animals in the home

Environments where pets were present also put patients at higher risk of infection. Nurses viewed the mere presence of a pet as introducing an additional source of risk. However, they also highlighted how, for some patients, their general hygiene practices and how they cared for their pets increased their risk. (Dowding 2020) (U)

The presence of pets and/or pests was also discussed as adding to the variability during the home care visit. (Pogorzelska-Maziarz 2020) (U)

Besides the client and nurse,[…] animals […] could be present during the delivery of care, varying from none to many; for example, […]pets, farm animals and pests. (Wendt 2022) (U)